Download free from www.tmrnursing.com TMR Integrative Nursing 2018 June; 2(2): 42-48 Review

Introducing Chinese therapy: A review of origin, developing course and modern application

Hui Shi1*, Wen-Li Zhu2, Ya-Mei Yuan1, Qing Tao1,2

1School of Nursing, Anhui University of Chinese Medicine, Anhui, ; 2Graduate School, Anhui University of Chinese Medicine, Anhui, China.

*Correspondence to: Hui Shi, School of Nursing, Anhui University of Chinese Medicine, Anhui, China. E-mail: [email protected]

Highlights Editor’s Summary This review introduced the origin, developing course Chinese food therapy, an important part of and modern application of Chinese food therapy in traditional Chinese medicine. The origins of traditional Chinese medicine to enrich our Chinese food therapy can be traced back to the understanding of relevant concepts and ways. “Sanhuanwudi” period. It is essential to know Chinese food therapy plays a more important role in clinics and family health care.

Citation: Shi H, Zhu WL, Yuan YM, et al. Introducing Chinese food therapy: A review of origin, developing course and modern application. TMR Integrative Nursing, 2018, 2(2): 42-48. DOI: 10.12032/TMRIN20180301 Submitted: 5 December 2017, Accepted: 6 December 2017, Online: 6 February 2018.

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ABSTRACT t Objective: This review introduced the origin, developing course and modern application of Chinese food therapy (CFT) in traditional Chinese medicine to enrich our understanding of relevant concepts and ways. Methods: PubMed, EMBASE, CBM, CNKI, VIP and Wanfang Databases were searched for papers on a range of terms relating to CFT. 41 references were finally selected for this review. Results: The development of CFT is comprised of five important periods in Chinese history. They are as following: the infancy period represented by the idea of homogeny of medicine and food; theoretical development period represented by Inner Canon of Yellow Emperor, Shennong’s Classic of Materia Medica and Treatise on Febrile and Miscellaneous Diseases; specialized volumes on CFT represented by Dietotherapy Worth a Thousand Gold; representative monographs on CFT represented by Dietetic Materia Medica and Principles of Correct Diet and the perfect period represented by integration of ancient food therapy practice and modern nutriology. Conclusion: CFT harbors a long and profound history, making great contribution to people’s health maintenance and illness prevention. With the further development of integrative medicine, CFT may play a more important role in clinics and family health care based on integration of syndrome differentiation and disease differentiation.

Key words: Chinese food therapy, Developing history, Traditional Chinese medicine, Homogeny of medicine and food

摘要

目的：本文回顾了中医食疗的起源、发展历程和现代应用，以增进我们对中医食疗中相关概念和方法的 理解。 方法：在 PubMed、EMBASE、中国生物医学威县数据库（CBM）、中国知网（CNKI）、维普及万方数 据库中检索与中医食疗相关的论文。 结果：本研究最终纳入 41 篇合格研究，结果显示：中医食疗的发展经历了五个重要时期，分别是以“药 食同源”的理念为代表的萌芽时期；以《黄帝内经》、《神农本草经》、《伤寒杂病论》为代表的理论发 展时期；以《食疗本草》、《膳食正要》为代表的食疗专著期；以辨症施食理论和现代营养知识有机融合 的完美时期。 结论：中国食疗历史悠久，内涵丰富，在维持健康、预防健康等方面做出了巨大贡献。随着中西医结合 护理学的进一步发展，基于辨病、辨证护理的有机结合，中医食疗将在临床护理和家庭保健中发挥更重 要的作用。

关键词：中国食疗；发展史；中药；药食同源

Abbreviations: TCM, Traditional Chinese medicine; CFT, Chinese food therapy. Competing interests: The authors declare that there is no conflict of interests regarding the publication of this paper. Copyright: © 2018 TMR Publishing Group. This is an open access article distributed under the terms of the Creative Commons Attribution Non Commercial license. Executive Editor: Jing Liang

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1. Introduction the same source since ancient times [7]. According to the record in HuaiNanZi, Shennong whose name literally Chinese food therapy, an important part of traditional means “divine farmer” tasted hundreds of herbs to search Chinese medicine (TCM), can be traced back to 3000 more edible herbs and was poisoned 70 times in a day years ago [1]. Under the guidance of the basic theory of while tasting various kinds of plants. During this process, TCM, food can be used to maintain health, treat diseases the scope of food was expanded in a large part to meet the and prolong life [2]. TCM holds that , blood, essence, needs of more and more people and ShenNong finally fluid and humor derived from food are the basic elements discovered medicinal plants unexpectedly. At that time, of human body and life-sustaining activities [3]. In there was little difference between the application of ancient times, there was little difference between the and that of medicine [8]. application of foods and that of medicine. Recipes for People began to eat cooked food instead of raw food foods were often similar to those for medicines [4]. since the discovery and usage of fire. Therefore, their A quote [5] by a great physician Bian Que describes brains acquired unprecedented development along with the role of doctor: “Firstly, physicians should have an the striking improvement of nutritional condition and insight into the cause of the disease and determine which cooking techniques [9]. It is said that Peng Zu made disharmony it prevails. The first and foremost measure is five-flavor chicken soup to treat Emperor Yao’s severe appropriate diet. One should never use medicine before anorexia successfully [10]. The brewing technique was the diet works.” Therefore, foods are mild therapeutic invented in the era of Yu and then drinking wine became agents that help the body stay balanced, or bring it back more and more prevalent. Ancient into balance. deemed that wine with the effect of dredging blood The theories, principles, approaches, and concepts of vessels, was the cream of five cereals and occupied a Chinese food therapy (CFT) scattered in voluminous prime position among medicines [11]. We can deduce that ancient books and modern literature [6]. It is of great fish and Chinese-date were used to treat illness in Shang importance to fully understand the complete developing Dynasty from Oracle bone inscriptions and other course of CFT. Only in this way can the practitioners unearthed relic [12]. have a comprehensive and systematic perception. So far, In Zhou Dynasty, people began to attach great there is no review published on this topic, consequently, importance to diet rather than alcoholic drinks to avoid intensive and extensive literature mining is urgently subjugation. Therefore, it had promoted the development needed to broaden the knowledge and systemize the of food therapy significantly [13]. Zhoulitianguan developing course of CFT. The origin, development and recorded the earliest nutritionists (Shi Yi) who were in present situation of CFT is shown in this review. charge of the emperor’s daily diet to prevent disease and preserve health. The nutritionists matched different kinds 2. Data sources of food according to their nature and reconciled the tastes based on the replacement of seasons. Therefore, its rank This paper is based on a literature search using major was much higher than the physician (Ji Yi), the surgeon relevant journals and databases to find out what have (Yang Yi) and the veterinarian (Shou Yi). Furthermore, already been written in English and Chinese. Six major physician and surgeon also thought highly of food electronic databases were retrieved for articles published therapy and it played a role of complementary treatment to April 2016, including PunMed, EMBASE, CBM, [14]. CNKI, VIP and Wanfang Data. Only articles in English During pre-Qin period, contents on food therapy were and were eligible. The following search found in non-medical books like Zhuang Zi, Mo Zi, Guan terms were used:“Chinese food therapy”, “herbal cuisine”, Zi, Han FeiZi and LvShiChunQiu [15]. The philosophical “dietotherapy” “dietary nursing”, “homogeny of medicine theories of hundred Schools of Thought advocated eating and food”, “Inner Canon of Yellow Emperor”, in a temperate manner and light diet instead of “Shennong’s Classic of Materia Medica”, “Treatise on high-protein and high-fat diet. The idea of valuing life Febrile and Miscellaneous Diseases”, “Dietotherapy nurturing pushed the development of food therapy to a Worth a Thousand Gold”. Conference proceedings and large extent [16-17]. Prescriptions of Fifty-two Diseases, dissertations were also searched from CNKI and Wanfang the oldest prescription book ever found in China, databases. 153 articles and 5 books were initially recorded 61 kinds of food which was approximately a identified. 78 articles were excluded after reviewing the quarter of the total medicines. Most of them were abstracts. All the rest of articles and relevant chapters of commonly used in our daily life, such as milk, honey, salt the selected books were read in detail. 39 articles were and lard. Half of the fifty-two diseases could be treated or eliminated because they are irrelevant to the topic. Finally, supported by food therapy [18]. 41 articles were chosen. 3.2 Theoretical development period represented by a serial of masterpieces 3. Results (1) The theoretical foundation of CFT represented by Inner Canon of Yellow Emperor (Huangdineijing). Inner 3.1 The infancy period represented by the idea of Canon of Yellow Emperor, the first systematic Chinese homogeny of medicine and food medical book, was compiled from the clinical experience There is a common saying that medicine and food share

Submit a manuscript: http://www.tmrjournals.com TMR Integr Nurs | June 2018 | vol. 2 | no. 2 | 44 Shi H, et al. Overview of Chinese food therapy and epidemiological observations of imperial physician Besides, foods were divided into five cereals, five during the Qin and Han periods (221 B.C.-220 A.D.) and vegetables, five fruits and five domestic animals. The regarded as the agglomeration of Chinese life science idea of balanced diet and varied food is in accordance [19]. Although there were no chapters to discuss food with that of modern nutriology. As it is said in the therapy, the related content scattered in each chapter was Chinese food guide pyramid, cereals, vegetables, fruits comprehensive and systematic. It issued improper eating and domestic animals provide us carbohydrate, vitamins, habits like over-eating and monophagia could lead to minerals, dietary fiber, high-quality proteins, fat and diseases. And it also emphasized that the five tastes water which are the most important nutrients for human (Table 1) of food should correspond to the function of beings [21]. In addition, the theory of meridian tropism five internal organs and thus maintained the harmony of also originated from this book and six out of the total 13 five tastes (Figure 1). For instance, it pointed out that medicinal diet formulas were recorded [22]. Based on people with liver diseases should avoid pungent food, above-mentioned statements, Inner Canon of Yellow people suffered from heart diseases should avoid salty Emperor constitutes the basic theory of Chinese food food, spleen diseases sufferers should avoid sour food therapy [20]. and people who have kidney diseases should avoid bitter (2) The Theory of Herbal Property Represented by food [20].

Figure 1: Organ-taste pattern in understanding the correlation between five organs and five tastes in Inner Canon of Yellow Emperor.

Table 1: Five tastes, their related function and representative foods in TCM Five tastes Function Food Pungency Promote the flow of qi and blood Ginger; black agaric Disperse wind; induce resuscitation Bitterness Promote defecation; clear heat; eliminate dampness Lilium brownli; balsam pear Sweetness Tonify deficiency; relax tension; alleviate pain; Red dates; sticky rice harmonize the middle Sourness Astringent; Dark plum; orange Promote the secretion of body fluid Saltiness Soften hardness and dissipate binds; purgation Laminaria japonica; sea cucumber

Shennong’s Classic of Materia Medica. Shennong’s relieving uneasiness of mind, these edible herbs gradually Classic of Materia Medica (Shen Nong Ben Cao Jing), become a part of daily diet for common people [24]. the earliest monograph on herbs, classified 365 kinds of Shennong’s Classic of Materia Medica which laid a medicinal plants into superior, medium and low grades. solid foundation for herbal property initiated the theories At that time, edible herbs were not separated from of four properties (Table 2) and poisonousness, and medicinal herbs. People began to realize the importance promoted the development of meridian tropism of the medicinal effect of food. Among those, a seventh substantially [25]. of them belongs to food and 36 kinds are listed as both (3) Fundamental Principle of CFT Represented by Treatise medicine and food issued by National health and family on Febrile and Miscellaneous Diseases. planning commission [23]. For instance, coix seed, Treatise on Febrile and Miscellaneous Diseases chrysanthemum, rhizoma dioscoreae, poria cocos, ginger (ShangHan Za Bing Lun), a monumental book honored as and so on. Influenced by losing weight, resisting hunger, the the originator of Chinese medical formulary, was improving hearing and eyesight, prolonging life and written by the famous physician Zhang Zhongjing

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(152A.D. - 219A.D.) in East Han Dynasty. It recorded the detailed up to 160 dietary contraindications and proposed first two specialized chapters Guo Shi Cai Gu Jin Ji and the principle of seasonal food contraindications. Animal Qin Shou Yu Chong Jin Ji which elucidated food liver, heart, lung, kidney and spleen were not sanitation and contraindications. It warned that “stale recommended to eat in spring, summer, fall, winter and meal, rotten meat and stinky fish should be avoided. long summer respectively [26]. Eating too much plum will decay the teeth. The meat Common food could be found in 15 percent of the must be rotten and inedible if it floats on the water. The overall 200 prescriptions. Some merely used food such as meat with white dots on it is inedible.” Furthermore, it

Table 2: Four properties, their related function and representative foods in TCM Four properties Function Indication Food Coldness & coolness Clear heat; eliminate toxin; moisten dryness; Heat syndrome Mung bean; engender fluid watermelon; Warmness & hotness Warm the middle; dissipate coldness Cold syndrome Mutton; pepper;

Baihejizihuang soup, Mijiandao Fang and Decoction of - 713A.D.), the student of Sun Si-miao, was especially Pig-skin (Zhufu soup). While others used food as well as skilled in food therapy and life nurturing. He compiled medicine such as the noted medicated diet recipe the first monograph on food therapy named Dietotherapy Dangguishengjiangyangrou soup, Ganmaidazao soup, of Materia Medica (Shiliaobencao) all over the world Guizhi soup and so on. Polished round-grained rice was [30]. Compared with other books, it supplemented the used for several times in this book and perceived as the therapeutic effect of animal offal, mushroom and alga early application of congee therapy. In summary, the main food such as bottom moss and Carex aridula, and idea of catering based on syndrome differentiation, was emphasized the dietary notes for pregnant women, regarded as the fundamental principle of CFT [27]. puerpera and children. It increased the edible and (4) Specialized Volume on CFT Represented by medicinal parts of food for the first time. For example, Dietotherapy Worth a Thousand Gold (Qianjinshizhi). Sun persimmon was subdivided into fresh persimmon, dried Simiao (581A.D. - 682A.D.) wrote a remarkable medical persimmon and mashed persimmon. It also emphasized book named Prescriptions Worth a Thousand Gold (Qian the source and the methods of preparing food. For Jin Fang). Sun inherited the essence of worthy example, dried dates could invigorate intestines and predecessor, integrated with his own clinical experience stomach and replenish Qi after being steamed while they and proposed two special volumes called food therapy could cause abdominal distention if they were raw. (Shi Zhi) and diet for the senile (Yang Lao Shi Liao) for It stated that pomegranate juice soaked in vinegar the first time. It is worth mentioning that some precious could treat diarrhea when taken on an empty stomach. content in the lost books such as Shennonghuangdishijin, Before the , siniperca chuatsi, weever, Bianqueshijin and Huatuoshilun was well preserved. water convolvulus, spinach, asparagus lettuce and mung Qianjinshizhi was the twenty-sixth volume of bean were recorded in medical book for the first time. It Prescriptions Worth a Thousand Gold. It collected one recorded the process, cooking and storage methods to hundred and fifty-four kinds of food and classified them maintain a good taste. However, the defect of this book into fruits, vegetables, grains and poultry and beasts. was that it merely recorded the four properties and Moreover, it recorded the therapeutic and life-nurturing ignored the five tastes [30]. effect of food other than recipe or food prohibition. For (2) The Most Influential Monograph on Food Therapy instance, seaweed, beef and goat liver, grain husk had Represented by Principles of Correct Diet (YinShan been mentioned to treat nutrient deficiency diseases such ZhengYao). The physicians attached more importance to as goiter, nyctalopia and beriberi respectively. When health preservation, health care and diet regulation in Jin caring patients with diabetes mellitus, Sun advocated the and Yuan Dynasties. Hu Si-hui, a royal doctor in Yuan importance of diet and pointed out that “salty or starchy Dynasty, wrote an influential book titled Principles of food should be used with caution [28]. Correct Diet (YinShanZhengYao). This book was of great Besides this, the 27th, 24th and 12th chapter academic importance and full of ethnic features. It went specifically discussed the method of food intake, beyond the old concept of food therapy and perceived introduced the way of detoxication by food. In addition, that laying more emphasis on nutrition to prevent diseases food therapy formulas were attached as an appendix. The was far better than taking medicine when people fall ill author concluded that food could eliminate pathogenic from the angle of nutriology. Compared with the old factors, stabilize the internal organs, rejoice emotion and concept of four properties, he subdivided it into 12 grades nourish qi and blood. He held the view that dietotherapy for the first time [31]. For example, coldness could be took precedence over pharmacotherapy [29]. subdivided into great coldness, mild coldness, tiny coldness and minor coldness. 3.3 Monographs on Chinese Food Therapy This book initiated various kinds of edible recipes of (1) The Emerge of Monographs on CFT Represented rare food and listed a wide range of food, both royal by Dietotherapy of Materia Medica. Meng (612A.D. delicacy for emperor and common food for ordinary

Submit a manuscript: http://www.tmrjournals.com TMR Integr Nurs | June 2018 | vol. 2 | no. 2 | 46 Shi H, et al. Overview of Chinese food therapy people. It also described the cooking methods and properties and five tastes. Therefore, apart from supplying attentions in details. When recorded each food, it basic nutrition, it has a therapeutic effect similar to emphasized its edible and tonic values related to the medicine [41]. Generally speaking, the idea of homogeny medicinal effect. For example, chicken cooked with of medicine and food represents the origin of CFT [7]. Shengdihuang (Rehmannia Glutinosa Libosch) could be Main contents in Inner Canon of Yellow Emperor, used to cure backache, the deficiency of bone marrow, Shennong’s Classic of Materia Medica and Treatise on fatigue and night sweat. Therefore, they were not only Febrile and Miscellaneous Diseases constitute the major delicious food but also fine medicine for preventing and theories and basic principles of CFT. Specialized Volume treating illnesses. Hu advocated that one should not eat in Dietotherapy Worth a Thousand Gold (QianJinShiZhi) until feeling hungry, never overeat especially in the night indicates that food therapy and food nurturing were on time, and not sleep when fully satiated [32]. the path driven by specialization [29]. Representative monographs, Dietotherapy of Materia Medica and 3.4 The perfect period represented by integration of Principles of Correct Diet, signify that contents on CFT ancient food therapy practice and modern nutriology do not need to attach to books on medicinal herbs any Nowadays, a large number of academic works on CFT more and mark that food therapy was accepted by more have been published such as Family Herbal Cuisine, and more people [30-31]. Last but not least, the organic Encyclopedia of Chinese Dietotherapy, Diet Therapy of integration of syndrome differentiation in CFT and TCM, Dietotherapy Formula for Pregnant and Lying-in disease differentiation in modern nutritional therapy Women and Food for Preventing Cardiovascular Diseases guides us to draw up more practicable program to double [33-34]. On the one hand, these books absorb the essence the efficacy [41]. Based on the above statements, we have of ancient literature such as the theories of four properties, confidence in the bright future of this ancient but vital five tastes, meridian tropism and major function. On the therapy. Further research is needed to reveal its biological other hand, they draw strength from modern nutriology foundation. 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